Association of ultra-processed food consumption with cardiovascular mortality in the US population: long-term results from a large prospective multicenter study

Table 2 Association between energy-adjusted ultra-processed food consumption (daily serving) and cardiovascular mortality

Causes of mortality	Quintiles of energy-adjusted ultra-processed food consumption, range (mean), servings/day					P_trend
Causes of mortality	< 0.5 (0.1)	0.5–< 1.1 (0.8)	1.1–< 2.1 (1.6)	2.1–≤4.0 (3.0)	> 4.0 (8.2)	P_trend
No. of participants	18,378	18,378	18,379	18,377	18,379
Person-years	247,441.39	247,018.70	247,436.48	247,501.44	246,651.21
Cardiovascular disease
No. of deaths	991	1006	1002	1135	1356
Death rate ^a	40.05	40.73	40.50	45.86	54.98
Model 1 ^b	1.00 (reference)	1.01 (0.93, 1.11)	1.01 (0.93, 1.11)	1.24 (1.14, 1.35)	1.62 (1.49, 1.76)	< 0.001
Model 2 ^c	1.00 (reference)	1.00 (0.91, 1.09)	1.01 (0.92, 1.11)	1.20 (1.09, 1.31)	1.50 (1.36, 1.64)	< 0.001
Heart disease
No. of deaths	670	689	683	846	1097
Death rate ^a	27.08	27.89	27.60	34.18	44.48
Model 1 ^b	1.00 (reference)	1.02 (0.92, 1.14)	1.01 (0.91, 1.13)	1.34 (1.20, 1.48)	1.87 (1.69, 2.06)	< 0.001
Model 2 ^c	1.00 (reference)	1.01 (0.90, 1.12)	0.99 (0.89, 1.11)	1.26 (1.13, 1.41)	1.68 (1.50, 1.87)	< 0.001
Cerebrovascular disease
No. of deaths	256	236	246	212	176
Death rate ^a	10.35	9.55	9.94	8.57	7.14
Model 1 ^b	1.00 (reference)	0.93 (0.77, 1.11)	0.99 (0.83, 1.19)	0.95 (0.79, 1.15)	0.90 (0.74, 1.10)	0.406
Model 2 ^c	1.00 (reference)	0.91 (0.76, 1.10)	1.04 (0.86, 1.25)	1.00 (0.82, 1.21)	0.94 (0.76, 1.17)	0.741

Values are hazard ratios (95% confidence intervals)
^a Crude death rate per 10,000 person-years
^b Adjusted for age (years), sex (male, female), race (non-Hispanic white, non-Hispanic black, Hispanic, others), educational level (college below, college graduate, postgraduate), marital status (married, widowed, divorced, separated, never married), and study center (10 categories)
^c Adjusted for model 1 plus aspirin use (yes, no), history of hypertension (yes, no), history of diabetes (yes, no), smoking status (current, former, never), alcohol consumption (g/day), body mass index (< 18.5, 18.5–24.9, 25.0–30.0, > 30.0 kg/m²), physical activity (min/week), and energy intake from diet (kcal/day)

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